A column from ASSH President L. Andrew Koman, MD

August 28, 2009

Dear Members,

This is my last column as your President. I want to say how honored I am to have been the President of the American Society for Surgery of the Hand during the past year. We have endeavored to increase the value of your society to all members by a variety of initiatives. These include surveying the members for their wants and needs and attempting to integrate these into the society, the elimination of programs which are no longer of value, and increasing educational opportunities. I hope you see you all at the Annual Meeting next week in San Francisco.

August 21, 2009

It is a little more than two weeks until the Annual Meeting which should be an incredible educational experience. Dave Ruch, MD, John Lubahn, MD, Donna Berger Stanton, and Melissa Thurlow have designed an outstanding scientific program for this year's joint meeting. San Francisco is a fabulous venue for Labor Day weekend. Joy Macdermid and I look forward to your paricipation.

As an aside, a scheduled medical television series "Royal pains" describes the world of concierge medicine with $200 house calls. Is there a role for concierge hand surgery? That is something to ponder.

June 05, 2009

If you had time to review the Presidential Update we sent out last night, you know that Council (your Board of Directors) decided that it was in the Society's best interest not to endorse the AAOS CTS guidelines on diagnosis and treatment. While we fully support the creation of robust, evidence-based guidelines, we felt that we could not offer our endorsement unless the organization writing guidelines is willing to change and update them as new evidence or concerns evolve. For those who are interested in our detailed response, you can click here to see our official letter to the Academy.

May 29, 2009

On May 28th, 2009, the Corporate Advisory Committee met with industry representatives to clarify disclosure and compliance protocols in physician-industry relations. It was somewhat prophetic that The Charleston Gazette headline read: "Drug company spending due today – some doctors received over $100,000 in ’08." This article documented companies which spent $16 million in direct consumer advertising and gave $16,000 in gifts, grants, or payments to physicians. There was no differentiation between CME support, research grants, royalties, or consulting, and the vast majority were between $50 and $1,250. Compliance and disclosure protocols were discussed from the perspective of health systems, universities, physicians, and industry.

How does this affect your society and you? First, you must understand conflict of interest (COI) and how it impacts you. There are moral, ethical and legal ramifications of COI issues. Morally and ethically, the litmus test is to do no harm to patients, hospitals, or insurance companies. "Harm" is not just physical but also economic. Additionally, you are not the customer because you do not pay for the product; but you select it, implant it, or prescribe it.

Multiple conflicts exist – including ego, but money is the most easily recognized and analyzed issue. For publications and presentations, the average monetary threshold is $500. The threshold for most institutional review boards for research (clinical and basic) is typically about $10,000. Above this amount, manageable conflicts fall between $10,000- 40,000 on average; and unmanageable levels exceed $40,000. Salaries from research grants are excluded.

There are no absolutes; however, following proper disclosure protocols is your best defense. Beware; disclose industry support to your hospital purchasing departments when asking them to stock products. Lastly, consider telling your patients if you have significant support from a company whose implant or drug you are recommending.

May 08, 2009

I have just returned from the meeting of the joint meeting of the British Society for Surgery of the Hand and the American Society for Surgery of the Hand, which was held in London, It was an outstanding scientific and educational experience. Our British counterparts were outstanding hosts and we discussed mutually beneficial collaborations for both societies. An example of cooperative member benefits is the ability of an ASSH member to purchase The European Journal of Hand Surgery at a 50% savings. Larger savings are possible if 50% or more of our members are interested n subscribing this outstanding journal. To determine interest, the Hand Society will send out a survey about interest in BJHS subscriptions next week.

April 16, 2009

Spring has finally come and, at least, in North Carolina, things are almost green.

Member benefits remain our primary concern. Please take advantage of our educational and business practice opportunities.

Registration is now open for the 2009 Annual Meeting in San Francisco this September; plan to attend and to register early and save on fees. Drs. Ruch and Lubahn have an outstanding program designed to fulfill everyone’s educational needs. Our speakers are Gary Poehling (an overview of arthroscopy), Kathy Reichs, the forensic pathologist and acclaimed novelist and creator of the "Bones " television series, as well as our acclaimed international speaker Professor Panayotis Soucacos from Greece. The venue should take care of the rest.

For those members that have not signed up for the Self-Assessment Exam, this is an outstanding educational product produced to the highest standards by your fellow-members.

At this Spring’s Board Meeting, we will be looking at ways to expand and improve the Journal: deal with methods to cope with the responsibility and burden of "hand" call; to identify additional educational products for distribution; to expand research opportunities that validate and define our clinical practices; and to better define appropriate clinical guidelines.

If you have a fellowship or residency, do not forget fellowship support grants and resident educational grants supported by industry from the AOA and OREF.

March 06, 2009

I hope this letter finds you well. Although the economic environment is miserable, we have jobs and the ability to help those less fortunate who are in need of our skills. Having just returned from the AAOS meeting in Las Vegas, the exhibits were smaller but the turnout was impressive. Drs. Osterman and Nagle did a great job with Specialty Day.

I received a very disturbing letter from a member whose local university has restricted Journal clubs to staff only - this is a setback to the communication of information, and it is hard to imagine how this decreases conflict of interest for anyone.If you encounter similar actions, please let us know.

February 20, 2009

One of the consequences of the Department of Justice investigation into the relationships betweenorthopaedic companies and orthopaedic surgeons, has been the need for third party oversight of many activities crucial to hand surgery. The AAOS, AOA, and OREF, have announced programs to distribute industry funds that impact the ASSH and its members.

Today, Bill Cooney, current Chair of the Board of trustees of OREF andformer President of your society notified members of the OREF that: "Under the agreements, OREF will receive and distribute funds from these companies to support a variety of projects, including graduate medical education fellowships and residency enhancement programs, and in one case, research and CME programs." How this program, the AOA Omega program, and the AAOS COA program will impact hand surgery is undetermined. However, the ASSH iscomposed of orthopaedic, plastic and general surgeons and is different from purely orthopaedic subspecialties.

I urge you to pay careful attention to the upcoming developments, when speaking with hand equipment companies, discuss the importance of support for hand training in addition to lower extremity total joints and recognize that the ASSH, a not-for-profit educational society, does not need a third party to prevent conflict of interest in our educational support from industry.

January 30, 2009

Recently, one of our esteemed members, Gordon McFarland, passed away. Gordon was a very active member of the ASSH and during his tenure as TREASURER, he was instrumental in starting our Foundation. He convinced the entire Council to jump-start the fund-raising by donating $1000 each. This occurred at the in San Antonio in 1987. We all know the rest of the story and are proud to be part of defining future care for our patients through the AFSH.

Gordon and all of our departed members will be missed by all of us. Perhaps during the beginning of a new year, we might reflect on how fortunate we are to be members of the ASSH; to care for our patients; and to have friends and colleagues who care and make a difference in the lives of others.

January 23, 2009

I just returned from the meetings of the American Association of Hand Surgery, the Peripheral Nerve Society, and the American Society of Reconstructive Microsurgery. All three events were of the highest scientific merit, and well-attended. Of special note, each organization’s president is an ASSH member.

In spite of the economic issues confronting all of us, I noticed the thirst for specialty knowledge and face-to-face exchange with peers appeared to be of great importance at the meetings. This is reassuring for both our Society and our patients. I was honored to represent the ASSH at these events, each of which documented the importance of continued educational and research missions.